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Archive for the 'immune system' Category

When friends complain about evil government (e.g., NSA surveillance), I tell them “never underestimate the stupidity of government employees” — by which I mean their stupidity outweighs their self-interest. The Obamacare website fiasco is a good illustration. Everyone has heard “power corrupts” but closer to the truth is power makes you stupid.

Rather than staging a long series of careful field trials with appropriate scientific evaluation, Salk darted ahead on his own in the remainder of 1953 and 1954. The trials were successful. The foundation released the results to the press, and such were the nation’s expectations that from that point there was no turning back. In August 1954 the foundation ordered five drug companies to begin producing mass lots of vaccine, on the basis of a formula for inactivating the virus with formaldehyde, according to a procedure Salk himself had devised. . . . James Shannon remembered very well what happened next. At this point he had become the associate director of the NIH. “I was working over the weekend and I got a telephone call from Los Angeles, and this is eight or nine o’clock on Friday night. It was the Health officer of the City of Los Angeles and he said they just had two reports of polio in some children who had been vaccinated nine days earlier. He wanted to know what should be done about it?”

One of the companies that contracted to make the vaccine, the Cutter Laboratories in Berkeley, California, had released several lots of vaccine that had been improperly inactivated. Live polio virus was being injected into children. The gratitude of the public turned to horror, as the cutter vaccine gave polio to almost 80 recipients; these children in turn went on to spread the disease to another 120 playmates and relatives; three quarters of the victims were paralysed and 11 died. . . . NIH’s Laboratory of Biologics Control, which had certified the Salk vaccine, had received advance warning of problems. . . .

In 1954 the rush was on. [Eddy’s] lab had gotten samples of the inactivated polio vaccine to certify on a “due-yesterday” basis. “This was a product that had never been made before and they were going to use it right away,” she recalled. She and her staff worked around the clock. “We had eighteen monkeys. We inoculated these eighteen monkeys with each vaccine that came in. And we started getting paralyzed monkeys.” She reported to her superiors that the lots were Cutter’s, and sent pictures of the paralyzed monkeys along as well. “They were going to be injecting this thing into children. . . .They went ahead and released the vaccine anyway, a lot of it. The monkeys they just disregarded.”

Shannon called the Surgeon General Satur­day morning. Additional cases of paralysis continued to occur. “It seemed obvious that we had a crisis on our hands, the magnitude of which was unknown.” Late Saturday afternoon a working group of senior virus specialists, whose advice the polio foundation had started to ignore a year earlier, began meeting in Shannon’s office. Note that Shannon had completely taken charge of the crisis. “Sebrell was not the man to manage this,” DeWitt Stetten recalled. ‘James Shannon was a man of quite different character.”

Shannon had brought in the Surgeon General, who called polio chief Basil O’Connor in New York. On Monday evening O’Connor and his advisers came down to Bethesda. Shannon wanted to withdraw the vaccine, “It was a very stormy meeting,” he said. “O’Connor and the polio group in general disallowed any possibility of induced infections [as a result of the vaccine]. … So Basil O’Connor stormed out with dire warning of what he was going to do to the NIH and the Public Health Service. Further vaccination was stopped. I had many sleepless nights.”

The basic problem had really not been the carelessness of the Cutter company, which rightly or wrongly was exonerated in a later report. It was the difficulty in jumping from Salk’s lab experiments with killing (formalinizing) the virus to large-scale industrial production.

. . . Ruth Kirschstein, the director today of an important NIH institute, added, “The Cutter incident resulted in everybody up the line who had anything to do with it—very few people know this story—being dismissed because of it.” All went out: the director of the microbiology institute lost his post, as did the equivalent of the assistant secretary for health. Oveta Culp Hobby, the secretary of Health, Education and Welfare (or Oveta “Culpable” Hobby, as she was known), stepped down. Dr. Sebrell, the director of the NIH, resigned.

Whereas I think the “basic problem” was overestimating the competence of powerful people, especially powerful experts.

As recently as four or five years ago,and for many years before that, I often had a runny nose. I went through boxes and boxes of Kleenex. I carried a handkerchief everywhere and often used it. Not because I had a cold–I almost never got colds. It was different than that. You might say I was mildly allergic to something in the air. (more…)

Anne Weiss recently repointed me to an interview with the epidemiologist Tom Jefferson about swine flu. Jefferson, let me stress, is a good epidemiologist. In the interview he makes a point I make on this blog, that research is heavily shaped by two questions: 1. what will make money? 2. what will be good for my career? (How curious that economists — with the exception of Veblen and Robin Hanson — spend so much more time on #1 than #2.) For example: (more…)

I have proposed that three things — a tendency to touch each other (e.g., shake hands), a tendency to touch near our mouths, and our tonsils — together form an early warning system for our immune system. The early warning system helps the immune system get tiny exposure to microbes circulating in the community. It performs self-vaccination. Like ordinary vaccination, exposure to tiny amounts of Microbe X protects against exposure to a large amount of Microbe X.

In Daniel Everett’s anthropological study of the Pirahã people (Don’t Sleep, There are Snakes: Life and Language in the Amazonian Jungle, 2009) he says the Pirahã “all touch one another frequently” (p. 85). “They loved to touch me too.” He has never seen kissing but “there is a word for it, so they must do it.” This supports the idea that a tendency to touch others is widespread.

If this theory is true, reducing microbe exposure to zero (e.g., sterile food) is a seriously bad thing. It’s been proposed that the polio epidemics of the first half of the 1900s were caused by cities becoming too clean.

Edward Jay Epstein reviewsA Wilderness of Error by Errol Morris. Janet Malcolm, among many others, assumed McDonald was guilty but new evidence suggests he was innocent.

Fermented food addiction. Several months ago I had a hard time not eating roasted peanuts. I kept buying them. Eventually the compulsion to eat them disappeared. Maybe they were supplying a nutrient I was deficient in.

Does sewer work improve your immune system? ” Sewer workers think so. “The [sewer workers] that Mayhew met were strong, robust and even florid in complexion, often surprisingly long-lived–thanks, perhaps, to immune systems that grew used to working flat out–and adamantly convinced that the stench that they encountered in the tunnels [while searching for valuable stuff, such as coins] “contributes in a variety of ways to their general health.”

In a recent post I made an obvious point. If our immune systems were stronger, we would need antibiotics less often and antibiotic resistance would become less of a problem. I hadn’t heard this point made (for example, this WHO report fails to say it). This was one example, I said, of how mainstream health care ignores the immune system. Perfectly obvious things, such as this idea about antibiotic resistance, fail to be noticed. I gave five more examples. Since then I have come across even more examples:

1. Hospitals do little to help patients sleep and often interrupt sleep, Nancy Lebovitz pointed out (better sleep –> better immune function). This article describes the problem. One way to improve hospital sleep — beyond don’t wake patients up — would be to provide exposure to strong sunlight-like light in the morning and prevent exposure to sunlight-like light after dark. I found that an hour of sunlight or similar light from fluorescent lamps in the morning improved my sleep. Most fluorescent light resembles sunlight (both have strong bluish components), incandescent light (reddish) does not. Until they install dual lighting systems (bluish light during the day, reddish light at night), hospitals can provide blue-blocker glasses to wear after dark.

2. The book Immortal Bird (sent me by the publisher) tells how Damon Weber, born with a defective heart, had a heart transplant when he was a teenager. After the transplant, problems arose. The doctors involved (at NewYork-Presbyterian ­Hospital/Columbia University Medical Center) took the problems to be signs of transplant rejection. In fact they were due to infection. Drugs given to deal with the mistakenly-assumed rejection suppressed Damon’s immune system. They reduced his ability to fight off the infection and he died. The author of the book, Damon’s father, sued the doctors and hospital for malpractice. The doctors did not exactly “ignore” the immune system, but they apparently failed to fully grasp the danger of immune suppression, even though the infection that killed Damon is common in transplant cases. (Although Columbia Presbyterian charged half a million dollars for the transplant, “three years into the lawsuit the [hospital’s] medical director claimed Damon’s post-op records couldn’t be located.”)

3. I asked a UCSF medical student what she’d been taught about the immune system. “We cover it!” she said. In a section called “Infectious Disease, Immunology, and Inflammation”. What makes the immune system work better or worse? I asked. “If you’re stressed out, it doesn’t work well,” she said. If you’re malnourished, like in Bangladesh. You need “nutrients and vitamins”. (A booklet I got telling me to take less antibiotics told me to “eat healthy”.) She also said the students get entire lectures on how to treat diseases so rare they might never be encountered. There is a whole section on genetics. Sure, they cover it. So superficially that they don’t remember the most basic idea: Better sleep –> better immune function. I said our health care system is built around first, let them get sick. That’s right, she said. Ignoring the immune system is an excellent way to allow people to get sick.

4. Melissa McEwen pointed out that proton pump inhibitors, such as Nexium, reduce the body’s ability to fight infection. They are prescribed for acid reflux and reduce how much acid the stomach makes. Because stomach acid kills bacteria, there should have been far more concern about their safety. “Proton pump inhibitors (PPIs) are among the most widely prescribed medications worldwide [billions of prescriptions]. . . . The collective body of information overwhelmingly suggests an increased risk of infectious complications,” says this article. Because the drugs are so common, the damage is great and, because of more infection, not restricted to those who take them. It could have been avoided by research into treatments that do not harm the immune system.